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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Hepatobiliary phases in magnetic resonance imaging using liver-specific contrast for focal lesions in clinical practice
Daniel Alvarenga Fernandes, Eduardo Andreazza Dal Lago, Felipe Aguera Oliver, Bruna Melo Coelho Loureiro, Daniel Lahan Martins, Thiago José Penachim, Ricardo Hoelz de Oliveira Barros, José de Arimatéia Batista Araújo Filho, Larissa Bastos Eloy da Costa, Áurea Maria Oliveira da Silva, Elaine Cristina de Ataíde, Ilka de Fátima Santana Ferreira Boin, Nelson Marcio Gomes Caserta
Daniel Alvarenga Fernandes, Eduardo Andreazza Dal Lago, Daniel Lahan Martins, Thiago José Penachim, Ricardo Hoelz de Oliveira Barros, Nelson Marcio Gomes Caserta, Department of Radiology, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
Felipe Aguera Oliver, Department of Radiology, Medical School, São Paulo State University- UNESP, Botucatu 18618-970, São Paulo, Brazil
Bruna Melo Coelho Loureiro, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo- InRad/HC-FMUSP, São Paulo 05403-010, SP, Brazil
José de Arimatéia Batista Araújo Filho, Department of Radiology, Sírio- Libanês Hospital, São Paulo 05652-900, SP, Brazil
Larissa Bastos Eloy da Costa, Department of Pathology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas 13083-888, São Paulo, Brazil
Áurea Maria Oliveira da Silva, Elaine Cristina de Ataíde, Ilka de Fátima Santana Ferreira Boin, Liver Transplant Unit, Department of Surgery, School of Medical Sciences, University of Campinas- UNICAMP, Campinas 13083-888, São Paulo, Brazil
Author contributions: Fernandes DA, Caserta NMG, and Boin IFFS designed the research study; Fernandes DA, Dal Lago EA, Oliver FA, and Loureiro BMC performed the research; Dal Lago EA, Oliver FA, Martins DL, Penachim TJ, Barros RHO, and Araújo-Filho JAB contributed analytic tools and analyzed the data; and All authors have read and approved the final manuscript.
Institutional review board statement: Project approved by the Institutional Research Ethics Committee, UNICAMP, opinion number 962.639, CAAE: 41531415.0.0000.5404. Identification of the study under the Universal Trial Number (UTN): U1111-1247-9655.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author at daniel_alvafer@yahoo.com.br. The presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Daniel Alvarenga Fernandes, Doctor, Medical Assistant, Research Associate, Department of Radiology, School of Medical Sciences, University of Campinas- UNICAMP, Rua Vital Brasil, 251, Cidade Universitária, Campinas 13083-888, São Paulo, Brazil. daniel_alvafer@yahoo.com.br
Received: February 23, 2022
Peer-review started: February 23, 2022
First decision: April 17, 2022
Revised: April 20, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: July 27, 2022
BACKGROUND
Challenging lesions, difficult to diagnose through non-invasive methods, constitute an important emotional burden for each patient regarding a still uncertain diagnosis (malignant x benign). In addition, from a therapeutic and prognostic point of view, delay in a definitive diagnosis can lead to worse outcomes. One of the main innovative trends currently is the use of molecular and functional methods to diagnosis. Numerous liver-specific contrast agents have been developed and studied in recent years to improve the performance of liver magnetic resonance imaging (MRI). More recently, one of the contrast agents introduced in clinical practice is gadoxetic acid (gadoxetate disodium).
AIM
To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions (FLL) in clinical practice.
METHODS
Overall, 302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL. Two radiologists independently reviewed the MRI exams using four stages, and categorized them on a 6-point scale, from 0 (lesion not detected) to 5 (definitely malignant). The stages were: stage 1- images without contrast, stage 2- addition of dynamic phases after contrast (analogous to usual extracellular contrasts), stage 3- addition of hepatobiliary phase after 10 min (HBP 10’), stage 4- hepatobiliary phase after 20 min (HBP 20’) in addition to stage 2.
RESULTS
The interobserver agreement was high (weighted Kappa coefficient: 0.81- 1) at all stages in the characterization of benign and malignant FLL. The diagnostic weighted accuracy (Az) was 0.80 in stage 1 and was increased to 0.90 in stage 2. Addition of the hepatobiliary phase increased Az to 0.98 in stage 3, which was also 0.98 in stage 4.
CONCLUSION
The hepatobiliary sequences improve diagnostic accuracy. With growing potential in the era of precision medicine, the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.
Core Tip: The translational objective was to determine the value of hepatobiliary phases using gadoxetic acid as a liver-specific agent in magnetic resonance imaging (MRI) in the characterization of benign and malignant focal liver lesions (FLL) in clinical practice. Morphofunctional MRI with gadoxetic acid in addition to the usual dynamic phases after contrast medium (arterial, portal and transitional/ equilibrium) increased the proportion of hits for differentiation between benign and malignant FLL in relation to the definitive diagnosis. The results suggest a relevant impact on the definition of strategies for the approach of focal hepatic lesions, as well as in the assessment of the treatment employed.
